BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH SERVICES (MHBG) U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

APRIL 2018 93.958 BLOCK GRANTS FOR COMMUNITY MENTAL HEALTH SERVICES (MHBG) State Project/Program: MENTAL HEALTH SERVICES U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Federal Authorization: Public Health Service Act, Title XIX, Part B, Subpart I and III, as amended, P.L. 102-321; 42 USC 300X N. C. Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services Agency Contact Person Program Walt Caison, Chief Community Mental Health Section NC Division of MH/DD/SAS 3004 Mail Service Center Raleigh, NC 27699 Phone: (919) 715-2361 Walt.Caison@dhhs.nc.gov Agency Contact Person Financial Celia S. Cox Budget and Finance NC Division of MH/DD/SAS 3013 Mail Service Center Raleigh, NC 27699-3013 Phone: (919) 715-2124 Celia.Cox@dhhs.nc.gov N. C. DHHS Confirmation Reports: SFY2018 audit confirmation reports for payments made to Counties, Local Management Entities (LMEs), Managed Care Organizations (MCOs), Boards of Education, Councils of Government, District Health Departments and DHSR Grant Sub recipients will be available by mid-october at the following web address: http://www.ncdhhs.gov/control/auditconfi rms.htm. At this site, click on the link entitled Audit Confirmation Reports (State Fiscal Year 2017-2018). Additionally, audit confirmation reports for Nongovernmental entities receiving financial assistance from DHHS are found at the same website except select Non-Governmental Audit Confirmation Reports (State Fiscal Years 2017-2018). The auditor should not consider the Supplement to be safe harbor for identifying audit procedures to apply in a particular engagement, but the auditor should be prepared to justify departures from the suggested procedures. The auditor can consider the Supplement a safe harbor for identification of compliance requirements to be tested if the auditor performs reasonable procedures to ensure that the requirements in the Supplement are current. The grantor agency may elect to review audit working papers to determine that audit tests are adequate. This compliance supplement should be used in conjunction with the OMB 2018 Compliance Supplement which will be issued in the summer. This includes Part 3 - Compliance Requirements, for the types that apply, Part 6 - Internal Control, and Part 4 - Agency Program requirements if the Agency issued guidance for a specific program. The OMB Compliance Supplement is Section A of the State Compliance Supplement. I. PROGRAM OBJECTIVES The Division of Mental, Developmental Disabilities and Substance Abuse Services has been awarded 14,943,566 to carry out the State s Plan for providing comprehensive community mental health services and supports to adults with a serious mental illness and to children with a serious emotional disturbance by funding community-based services through an area authority or through B-4 93.958 1

a county program established pursuant to G. S. 122C-115.1. The focus is on ensuring that services of varying intensity are available and accessible and are evidence based practices when available and frequent and appropriate use of peer led interventions that infuse the service array with recovery and wellness practices. The program objective is to provide comprehensive community mental health services and supports. Local Management Entities/Managed Care Organizations (LME/MCOs) and nonprofit contractors use these funds to carry out a variety of allowable activities within the covered services included in NCTracks. Exception: MHBG funds may not be used for inpatient services. Services include, but not limited to: Evidence-Based Practices (EBPs) Assertive Community Treatment (ACT) Individual Placement and Support Supported Employment (IPS-SE) Integrated Dual Disorders Treatment (IDDT): Integrated Care Substance Use and Mental Illness Peer Services First Episode Psychosis (FEP) The mandated 10% set-aside for persons with first episode psychosis (FEP) are allocated to three LME/MCOs to contract for services as directed in the Guidance for Revision of the FY2016-2017 Block Grant Application for the New 10% Set-aside issued by SAMHSA in February 2016. Funding may only be used for evidence-based programs. The Division has selected Coordinated Specialty Care Teams, a model recognized by SAMHSA as evidence-based. DMHDDSAS requires its Coordinated Specialty Care (CSC) teams to include peer support. One additional site tests innovative practices including ways to increase social support and help young people regain skills and confidence in the social arena. The CSC Teams address the young person s dreams of recovery in addition to addressing symptom reduction. Funds are also allocated to a LME/MCO for a contract with a provider for database development, clinical consultation, technical assistance and fidelity monitoring for any MHBG set aside FEP funded program. Program Objectives: To provide early intervention and treatment to clients ages 15-30 who are experiencing their first onset of psychosis To provide assertive outreach to promote early engagement in treatment and intervention To provide integrated medical/psychosocial care focused not only on symptomatic recovery but also on social and functional recovery To provide community education about early episode psychosis, including identification and referral, to community providers and stakeholders MHDDSAS services funded through the LME/MCO, DMH/DD/SAS contracts with the following nonprofit agencies to carry out specific program objectives: Systems of Care Children with serious emotional disturbances face challenges in many aspects of their daily lives-at home, in school, in social situations and in the community. Because of this, they need coordinated services and supports from a variety of child-serving agencies as well as natural supports located in their home communities. B-4 93.958 2

Systems of Care (SOC), is supported in North Carolina, are coordinated networks of community services and supports that are organized to meet these challenges. The system of care model is not a program; it is a philosophy of how care should be delivered. This approach to services recognizes the importance of family, school and community and promotes each child's full potential by addressing physical, emotional, intellectual, cultural and social needs. System of Care Approach The mental health service system is driven by the needs and preferences of the child and family, using a strengths-based perspective. Family involvement is integrated into all aspects of service planning and delivery. Services are built on multi-agency collaboration and grounded in a strong community base. A broad array of services and supports are provided in an individualized, flexible, coordinated manner and emphasize treatment in the least restrictive, most appropriate setting. Governor s Institute on Alcohol and Substance Abuse, Inc. The PIC addresses Mental Health, Intellectual/Developmental Disabilities and Substance Use practices. The MHBG funds support the Mental Health portion of the PIC. NAMI North Carolina, Inc. The intent of the Division s mission is to provide increased access to quality, effective consumerand family-driven services and supports that demonstrate improved outcomes for the consumer and the system. With this contract, consumer driven services and supports promote well-being for children with serious emotional disturbance (SED) and their families and communities, as well as adults with serious mental illness (SMI). NAMI NC s work in past years has assisted the Division to this end. This year s work will continue to contribute to the Division s ability to act on its mission and achieve reform outcomes through an array of targeted, evidenced, informed consumer/family driven best practices for those most seriously in need of services and supports. This contract assists the DMHDDSAS in its mission via the following objectives: Families, children, youth, and adult consumers directly affected by serious mental illness (for children, serious emotional disturbance), including those experiencing First Episode Psychosis (FEP), will receive information and support through the Family-to-Family Education Program, NAMI Basics Parent Education Program, Parent and Teachers as Allies, In Our Own Voice, Peer-to-Peer programs, Support Group Facilitator programs, Veterans and military outreach, CIT (Crisis Intervention Team) training with law enforcement and school resource officers, school mental health and transition initiatives such as Positive Behavior Intervention & Supports (PBIS), NAMI on Campus, Text for Teens, suicide prevention, reducing stigma, healthy schools and healthy youth transition recovery and wellness, Monday Messages, linked to or provided Mental Health First Aid training and WRAP planning, self-advocacy supports, promote supported employment best practices (IPS-SE) and Psychiatric Advance Directives (PAD) in coordination with the division, and research peer directed recovery and crisis supports and services. Callers to the NAMI-NC Helpline will receive high-quality information, referral and support services through increasing accessibility and operation of the NAMI-NC Helpline. B-4 93.958 3

Citizens of North Carolina who are most directly affected by and living with serious mental illness will have access to mental health information and support through educational materials, conferences, workshops training, scholarships and other events. DMH Contracts Leadership Fellows Academy This contract with The University of North Carolina at Chapel Hill, School of Social Work, Jordan Institute for Families addresses the shortage of consumer operated / consumer run service organizations and advocacy organizations. The definition that is being used for consumer run / consumer operated is the one utilized by SAMHSA which states that at least 51 percent of the board of directors must be consumers. UNC-CH, School of Social Work, Jordan Institute for Families has been awarded $200,000 for developing and providing a 12 week Community Leadership Development Training Academy in collaboration with NCSU Institute for Nonprofits. Funds support partial FTEs, equipment, consultants, materials & supplies, and travel. By the end of the contract cycle participants will demonstrate a 50% increase in their knowledge of Budgeting, Financial Management, Program Evaluation, Board Development and Reporting and the 12-week curriculum will assist state planning council teams build essential leadership skills among council chairs, vice-chairs, other members and other behavioral health planning leaders, inclusive of coaching, mentoring and stakeholder engagement. RHA Deaf Services In SFY17, the state began contracting directly with RHA Behavioral Health to provide MH/SUD services to this population across the state. This direct service contract allows the Division to achieve budget efficiencies and ensure services are provided evenly across the state. Prior to SFY17, these services were managed and contracted out through the LME-MCOs. Total funding for this service is $1,614,187 and $457,558 supported by the MHBG. RHA employs 10 full time licensed clinicians (LCSWs, licensed counselors, licensed psychologists), 6 Outreach Consultants (3 are certified Peer Support Specialists with lived experience), a program director, business manager and a part-time administrative assistant. All staff are fluent in sign language as measured by the Sign Language Proficiency Interview (SLPI). About 90% of contract staff are deaf. Copies of position descriptions are available electronically. DMHDDSAS hosts a Deaf Mental Health Advisory Council (MHAC) to advise the Division on services and provide feedback related to programming. The 13-member Council meets four times per year in Raleigh. Most of the Council members are deaf and some identify as being in recovery. Further, the Division hosts three Community Listening Sessions each year at selected sites across the state to obtain feedback about programming and services. II. PROGRAM PROCEDURES First Episode Psychosis (FEP) 10% of MHBG funds are allocated to LME/MCOs for First Episode Psychosis Services with specific conditions for use of funds specified in allocation letters. Programs are expected to bill for services covered by private insurance and Medicaid. There are no specific instructions from B-4 93.958 4

SAMHSA regarding the use of state funds. FEP set-aside funds may be used to cover services of evidence-based Coordinated Specialty Care Teams that are not otherwise billable. Governor s Institute on Alcohol and Substance Abuse, Inc. The NC Practice Improvement Collaborative (NC PIC) is modified somewhat from previous fiscal years. The current emphasis is on communication and dissemination of information about the effective evidence-based practices for children and adults with mental health disorders. Many of these EBPs are preventive in nature, reducing risk and improving outcomes in specific target populations (prevention education and community-based process strategies). NAMI North Carolina, Inc. The MHBG State Plan to provide services that are evidence informed best practice, NAMI-NC, will continue to build both regional and statewide capacity for the delivery of the NAMI North Carolina educational and outreach programs, services and supports and will continue to enhance the provision of high-quality information, referral, and support services through the marketing and operation of the NAMI North Carolina Helpline. Some of the outcomes and deliverables expected from the objectives outlined above include: Objective 1. NAMI will implement best practice educational and outreach programs statewide, targeting specific regions and communities in collaboration with the LME/MCOs and community consumer/family, partners and provider agency needs identified; reports will reflect all activities and outcomes. Objective 2. Helpline services and data collected will help inform the development of outreach and education as needed in communities across North Carolina; reports will reflect data collected and utilization of such. Objective 3. NAMI will develop, present and distribute materials for outreach and education to help increase access to and sustained engagement in necessary treatment services and supports for those in need of treatment. NAMI will promote use of evidence-based and promising practices, including consumer/family driven person centered planning, and symptom management; all that builds resilience and promotes recovery and wellness among population groups, including children, youth, adult consumers, family members, veterans/military families, and community stakeholders/help givers. NAMI will promote wellness and mental health promotion, suicide prevention and peer and family supports to increase consumer and family well-being, recovery, and engagement in treatment services and supports. NAMI will facilitate awareness days/weeks throughout the year for general population and targeted activities for adults with mental illness and children with or at risk for serious emotional disorders and behavioral health challenges. NAMI will continue to work with their volunteer affiliates across the state to include family and consumer participation in the planning and execution of the CIT training events with emphasis on recruitment of School Resource Officers and others who can impact on school age youth. NAMI will plan and implement training and provide education related to PADs, WRAP planning, promote suicide prevention, and promote access to/research of peer directed crisis services and supports in coordination with the division. NAMI will plan and hold an annual fall conference and two regional spring meetings. NAMI and its Family Advocates will make presentations at local NAMI affiliate events and those sponsored by other community agents, and work to improve the quality of IPS - B-4 93.958 5

Supported Employment through its collaboration with DMH/DD/SAS IPS staff, participation in local IPS - Supported Employment steering committees and fidelity reviews, and participation in monthly Dartmouth calls and meetings related to family advocacy. Services and Supports Transitions to Community Living Initiative (TCLI) TCLI has provided the framework we are actively applying to our State funded Adult Mental Health Service Array. Using the Olmstead Act and the Americans with Disabilities Act to ensure what we plan and implement aligns with our community integration mandate, viz., community based services and supports are available and vary in clinical intensity, services are infused with recovery focused practices that pull from psychiatric rehabilitation and other evidence based practices, and service providers are actively supporting individuals identify, engage in, and become active members of their community. Mental Health Recovery The Adult MH Team is identifying ways and practices that can bring recovery into the AMH service array. Some of our plans include: increasing DMHDDSAS staff knowledge on psychiatric rehabilitation so this practice can then influence our service delivery, identifying emerging best practices that focus on community involvement and integration, researching service models not yet used in NC for pilot consideration. Other division staff are working to develop and evolve a grass-roots mental health recovery movement statewide, grounded in both a statewide organization as well as a number of related local collaboratives a hot topic at the recent 9th Annual NC One Community in Recovery Conference, November 8-10, 2017, sponsored by DMHDDSAS. GAST The Geriatric/Adult Specialty Team (GAST) program provides training to staff working with older adults living in the community. GAST began in 2003, focusing on long-term care facilities in response to the closing of NC s state psychiatric hospitals gero-psych units. Over the years the program s mission has expanded to include caretaker training in such community settings as senior centers, day programs and psychosocial rehabilitation centers, and in conjunction with social services, law enforcement and first responders. Training is designed to help geriatric caretakers understand how mental illness, especially depression and anxiety, manifests in older adults. It especially focuses on how to recognize suicide thoughts, and substance use / misuse. GAST trainings and brochures routinely review how older adults can access mental health services through NC s LME-MCO network. The NC Mental Health and Substance Use Aging Coalition was established five years ago. It now has over 300 members, many of whom are older adults. The Coalition provides advocacy and education to communities, and promotes evidence based practices for older adults. Substance Use and Mental Health Enhanced Services ACT Substance Use Specialist, whole team practice of IDDT, monitoring of provision of co-occurring disorders treatment, Motivational Interviewing and interventions in line with stages of change IPS- practice principles align with best practices for SU, specifically zero exclusion and rapid job search Outpatient services Comprehensive Clinical Assessments are required to assess for substance use, and determine a diagnosis if clinically indicated Fidelity monitoring processes support IDDT practices B-4 93.958 6

Housing Oxford House Outreach Homelessness(Path) Transitions to Community Living Initiative (TCLI) Integrated Community Living LME/MCO must perform Diversion, In-Reach, and Transition activities for the population specified in the August 2012 Settlement Agreement between the State of North Carolina and the U.S. Department of Justice and according to the requirements of this section. LME/MCO shall make all services in the TCLI benefit package included in the DMH/DD/SAS approved adult services array, including Peer Support Services, IPS-SE, and ACT, available to TCLI participants. In addition to the other general provisions of this Contract related to special populations, the following activities are required for individuals in the TLCI Benefit Plan, as specified by DHHS, and shall follow the requirements outlined in the DOJ Settlement Agreement and subsequent DHHS-approved, related plans to include: Transition Planning Transition Planning refers to the process of developing a person-centered transition plan to assist an individual in transitioning from an Adult Care Home or State hospital to a more integrated community living arrangement. This plan shall be used by the treatment provider to develop the person-centered recovery treatment plan. LME/MCOs shall ensure that all transition planning is person-centered and follows the guidelines set forth by DHHS in support of the DOJ Settlement Agreement. Subject to available funding allocated to the LME/MCO for this purpose, LME/MCO shall hire or contract for in-reach and transition staff who meet one of the following qualifications: Care Coordinator Certified Peer Support Specialist (must be Certified Peer Support Specialists within six (6) months of being hired). Meet at least Qualified Professional (Mental Health/Substance Abuse) minimums for education and training. Transition staff roles/expectations: Assure that discharge/transition planning occurs timely and effectively Ensure the development of an effective, person-centered transition plan for the TCLI Population that includes all required elements for a successful transition. Diversion The LME/MCO will assign staff or contract with an adequate number of staff to account for the number of individuals covered under the population definitions/criteria to carry out the requirements of the DOJ Settlement related to diverting individuals from admission to licensed Adult Care Homes. The LME/MCO will produce for the DMH/DD/SAS their criteria and analysis that demonstrates adequate staffing levels. The LME/MCO will: Ensure that all individuals in the TCLI priority population process of diversion have the elements of community integration plans a Community Integration Plan (CIP) that meets requirements standards set by DHHS. LME/MCOs shall ensure that all CIPs meet DHHS quality standards and pass DHHS quality reviews. Review the CIPs to ensure they are completed with clear documentation that informed choice drove the individual s decision and the degree to which that decision has been implemented. Review the PASRR/PASD information to assess if individuals are eligible for Medicaid services, or State-funded services as available, are offered to individuals whether moving to the community or to an Adult Care Home. Connect individuals who have had CIP with services and supports that they are eligible for and determine if person is housing slot eligible. Assure that individuals who choose to be admitted to an ACH are referred for In-Reach, per the In- Reach requirements of the DOJ Settlement Agreement. B-4 93.958 7

In-Reach The LME/MCO must be able to demonstrate the sufficiency of staffing levels to perform In-Reach activities for the TCLI Population upon request by DMH/DD/SAS. In-Reach activities must include at a minimum the following and will be documented using the DHHS designed Transition to Community Living Database. Explaining fully the benefits and financial aspects of clinically-appropriate community-based integrated settings, including supported housing; Facilitating and accompanying individuals on visits to supported housing options/locations; Assessing Adult Care Homes residents interest in supported housing; Exploring and addressing the concerns of any of Adult Care Home residents who decline the opportunity to move to supported housing or who are ambivalent about moving to supported housing despite being qualified for such housing; Ensuring tenancy support transitions to housing are coordinated; Explore the individual s interest in finding employment, provide basic benefits counseling/information, and/or continuing their education; Reports made by LME/MCO staff or providers to the State, in accordance with State law, regarding concerns about rights of individuals, suspected potential abuse, neglect, or exploitation that arise during the in-reach and transition process; and Completing the DHHS In-Reach Tool for each individual. Tenancy Support Services Tenancy support services may be provided through ACT providers or through separate tenancy support providers. For those eligible for the TCLI benefit package, tenancy support services should be available at least twice per month for all individuals approved for a TCLI housing slot and not receiving tenancy support through ACT services. TCLI Supportive Housing Efforts The LME/MCO shall accomplish the milestones required under the Transitions to Community Living Initiative (TCLI) related to supportive housing for individuals in the TCLI Benefit Plan. A designated single point of contact (Housing Coordinator) at the LME/MCO shall be identified to coordinate all housing efforts and work closely with other TCLI team members. The LME/MCO shall fulfill the following general requirements: Educate and be a resource of support to TCLI consumers, families and service providers in identifying, accessing and maintaining affordable housing, Maintain minimum staffing levels through contracts or FTEs to ensure coordination of housing activities Ensure LME/MCO-specific housing goals as established annually by the DHHS are met. The Department and the LME/MCO will determine the number of slots it will fill for each year of the settlement agreement in accordance with NCGS 122C-20.10. Individuals with SPMI who are residing in ACHs licensed for between 20-49 beds in which 40% or more of the resident population has a mental illness; Individuals with SPMI who are or will be discharged from a State Psychiatric Hospital and who are homeless or have unstable housing; Individuals diverted from entry into ACHs pursuant to the pre-admission screening and diversion process; Individuals provided and referred to supported employment (data must be reviewed and validated by LME/MCO); Individuals in the In-Reach process; and Individuals in the TCLI Benefit Package. Military and Veterans Programming Initiatives Founded by clinical Health Professionals in 2006 as the Governor s Focus Group on Service members Veterans, and their Families, in partnership with the Governor s Institute on Substance Abuse, it is known today as the GOVERNOR S WORKING GROUP on Veterans, Service members and their Families (GWG). The GWG has grown to become a nationally recognized forum, which hosts a monthly meeting, newsletter, and website (http://ncgwg.org), as well as a YouTube Channel (https://www.youtube.com/watch?v=p2cwzhxzho4&feature=youtu.be). This real-time referral and collaboration network cuts red tape linking decision makers, service providers, and military members (current and former) and their families together in a best-practices sharing environment. B-4 93.958 8

Charged with facilitating collaboration and coordination among ALL Federal, State, Local, and Non-Profit partners who work with North Carolina s nearly 740,000 Veterans and their families, monthly sessions highlight: Health and Wellness, including Behavioral Health Transitional Services Veterans Benefits and Claims Community-based Services and Supports Housing Resources Education and GI Bill Job Creation and Workforce Enrichment Legal and Financial Services III. COMPLIANCE REQUIREMENTS The Type of s can be found in Section B in the link: 2018 Agency Matrix for Federal Programs. This matrix incorporates the OMB Compliance Supplement Part 2 - Matrix of. A State Agency may have included a Y, even if the compliance requirement normally does not pass to a subrecipient, or an N, indicating that the compliance requirement normally does not apply. However, if specific information comes to the auditor s attention that provides evidence that a compliance requirement could have a direct and material effect on the major program, the auditor should test it. This should arise infrequently. Crosscutting Requirements The DHHS/Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) mandates that all the testing included within the crosscutting section be performed by the local auditors. Please refer to that section, which is identified as DMH-0 for those mandated requirements. A. ACTIVITIES ALLOWED OR UNALLOWED ALLOWABLE ACTIVITIES: 1. Services provided with MHBG funds shall be provided only through appropriate, qualified community programs in coordination with Local Management Entities (LMEs) (which may include community mental health centers, child mental health programs, psychosocial rehabilitation programs, mental health peer support programs and mental health primary family, youth, consumer-directed programs). Services under the plan will be provided through community mental health centers only if the services are provided as follows: a. Services principally to individuals residing in a defined geographic area (service area); b. Outpatient services, including specialized outpatient services for children, the elderly, individuals with serious mental illness, and residents of the LME catchment areas who have been discharged from inpatient treatment at a mental health facility; c. 24-hours-a-day emergency care services; d. Day treatment and other partial hospitalization services or psychosocial rehabilitation services; or e. Screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission (42 USC 300x-2(b) and (c)). The activities of this grant are consistent with the State Plan and are specified in the contract (see program procedures section above). These activities include: evaluating the programs and services delivered under these contracts, and educational/training activities related to providing services under the MHBG State Plan. B-4 93.958 9

FEP services include assertive engagement, case management, individual and family psychoeducation and therapy, medication management, crisis intervention, supportive employment and education and peer support, community outreach and education, clinical consultation, technical assistance, database development and management and fidelity monitoring. UNALLOWABLE ACTIVITIES: The funds for this contract are not used to: (1) Provide inpatient hospital services. The Division ensures compliance with inpatient service prohibition by not reimbursing inpatient service with MHBG funds through NCTracks; (2) Make cash payments to intended recipients of health services; (3) Purchase or improve land, purchase, construct or permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment unless the State has obtained a waiver from the Secretary of HHS; (4) Satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; (5) Provide financial assistance to any entity other than a public or non-profit entity. B. ALLOWABLE COSTS/COST PRINCIPLES All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the cost principles described in the N. C. Administrative Code at 09 NCAC 03M.0201 and in 2 CFR, Part 200 Subpart E Cost Principles.) Restrictions on LME, Provider, and Contractor Use of BG Funds MHBG funds are prohibited from being used towards the annual salary of any LME, provider, or contractor employee, consultant, or other individual that is in excess of Level I of the most current federal Executive Salary Schedule. This amount is designated for calendar year 2016 at an annual salary of $205,700. https://www.opm.gov/policy-data-oversight/payleave/salaries-wages/salary-tables/pdf/2016/ex.pdf Assurances on LME, Provider, and Contractor Use of BG Funds 1. Funds are used to provide services to adults with Serious Mental Illness (SMI) and children with Severe Emotional Disturbance (SED). 2. Funds are used to provide for a system of integrated services appropriate for the multiple needs of children without expending the grant for any services other than comprehensive community mental health services. Examples of integrated services include: Social services; Educational services, including services provided under the Individuals with Disabilities Education Act; Juvenile Justice services; Substance Use services; and Health and mental health services. 3. Funds are used to provide access to services to underserved mental health populations including homeless persons, rural populations, older adults, children and youth with cooccurring disorders, and adolescents transitioning into adulthood. 4. FEP services are directed to individuals ages 15-30 who have experienced their first onset episode of psychosis through evidence-based treatment by Coordinated Specialty Care Teams. B-4 93.958 10

C. CASH MANAGEMENT These funds are earned/reimbursed based on the following: 1. Funds are earned through the NCTracks based on allowable activities provided by the entity receiving the funds, and/or 2. Funds are reimbursed based on actual expenditures incurred and certified by the Local Management Entity/Managed Care Organization (LME/MCO), or 3. Funds are reimbursed based on actual expenditures incurred and certified by the contractor. The N. C. DHHS Controller s Office is responsible for submitting Financial Status Report 269 to the Federal Grants Management Officer for documentation of federal funds expended, according to the N. C. DHHS Cash Management Policy. E. ELIGIBILITY The mental health services of the LME/MCO are provided to any adult with Serious Mental Illness (SMI) [NCTracks Target Population - AMI] or child with Severe Emotional Disturbance (SED) [NCTracks Target Population - CMSED] residing or employed in the services area of the LME/MCO, regardless of ability to pay for such services. Governor s Institute on Alcohol and Substance Abuse, Inc. The target population is the general public, consumers, providers and LME/MCOs. Dissemination is also targeted toward colleges and universities that prepare practitioners. NAMI North Carolina, Inc. Adults who live with serious mental illness and their family members. Children and youth who are at risk for or who experience serious emotional disturbance and their families. Deaf Services Adults who are deaf and live with serious mental illness and their family members. Children and youth who are deaf and disturbance and their families. at risk for or who experience serious emotional F. EQUIPMENT AND REAL PROPERTY MANAGEMENT Equipment Management This requirement refers to tangible property that has a useful life of more than one year and costs of $5,000 or more. Such equipment may only be purchased per the conditions of the approved contract or grant agreement. Should the contract be terminated, any equipment purchased under this program shall be returned to the Division. Real Property Management This requirement does not apply to DMH/DD/SAS contracts. B-4 93.958 11

G. MATCHING, LEVEL OF EFFORT, EARMARKING Matching Not applicable at the local level. No testing is required. Level of Effort Level of Effort must be maintained since regulations require that MHBG funds shall be used to supplement and increase the level of State, local and other non-federal funds and shall, in no event, supplant such State, local and other non-federal funds. If MHBG funds are reduced, the Local Management Entity/Managed Care Organization may reduce its participation in a proportionate manner. Maintenance of Effort is determined at the State level. Earmarking Not applicable at the local level. No testing is required. H. PERIOD OF PERFORMANCE This requirement does not apply at the local level. I. PROCUREMENT AND SUSPENSION AND DEBARMENT Procurement All grantees that expend federal funds (received either directly from a federal agency or passed through the NC Department of Health and Human Services) are required to comply with the procurement guidelines found in 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards which can be accessed at: https://www.gpo.gov/fdsys/pkg/fr-2013-12-26/pdf/2013-30465.pdf. All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the procurement standards described in the North Carolina General Statutes and the North Carolina Administrative Code, which are identified in the State of North Carolina Agency Purchasing Manual, accessible at http://www.pandc.nc.gov/documents/procurement_manual_5_8_2013_interactive.pdf. Nongovernmental sub-recipients shall maintain written procurement policies that are followed in procuring the goods and services required to administer the program. Suspension and Debarment All grantees awarded contracts utilizing Federal dollars must be in compliance with the provisions of Executive Order 12549, 45 CFR Part 76 and Executive Order 12689. J. PROGRAM INCOME This requirement does not apply at the local level. L. REPORTING 1. For funds allocated through UCR, Local Management Entities/Managed Care Organizations (LME/MCO) report services delivered to eligible adult and child mental B-4 93.958 12

health clients through Unit Cost Reimbursement (UCR) will report via NCTracks effective July 1, 2013. 2. For funds allocated as non-ucr funds, any applicable reporting requirements will be set forth in specific allocation letters to Local Management Entities/Managed Care Organizations (LME/MCO). For Contract Reporting: Financial Status Reports (FSR) will be submitted by the 10 th of the month. Quarterly reports on the deliverables in the contract are also required. M. SUBRECIPIENT MONITORING Monitoring is required if the agency disburses or transfers any State funds to other organizations, except for the purchase of goods or services, the grantee shall require such organizations to file with it similar reports and statements as required by G. S. 143C-6-22 and 6-23 and the applicable prescribed requirements of the N. C. Office of the State Auditor s Audit Advisory #2 (as revised January 2004), including its attachments. If the agency disburses or transfers any pass-through federal funds received from the State to other organizations, the agency shall require such organizations to comply with the applicable requirements of 2 CFR Part 200.331. Accordingly, the agency is responsible for monitoring programmatic and fiscal compliance of subcontractors based on the guidance provided in this compliance supplement and the audit procedures outlined in the DMH-0 Crosscutting Supplement. N. SPECIAL TESTS & PROVISIONS All grantees are required to comply with the N. C. Department of Health and Human Services and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services records retention schedules and policies. Financial records shall be maintained in accordance with established federal and state guidelines. The records of the contractor shall be accessible for review by the staff of the N. C. Department of Health and Human Services and the N. C. Office of the State Auditor for the purpose of monitoring services rendered, financial audits by third party payers, cost finding, and research and evaluation. Records shall be retained for a period of three years following the submission of the final Financial Status Report or three years following the submission of a revised final Financial Status Report. In addition, if any litigation, claim, negotiation, audit, disallowance action, or other action involving these funds has been started before expiration of the three year retention period, the records must be retained until the completion of the action and resolution of all issues which arise from it, or until the end of the regular three year period, whichever is later. The grantee shall not destroy, purge or dispose of records related to these funds without the express written consent of N. C. DHHS-DMH/DD/SAS. The agency must comply with any additional requirements specified in the contract or to any other performance-based measures or agreements made subsequent to the initiation of the contract including but not limited to findings requiring a plan of correction or remediation in order to bring the program into compliance. There shall be evidence of LME support for the promotion, provider training, implementation and monitoring of evidence-based treatment services for adults. B-4 93.958 13

There shall be evidence of LME support for the promotion, provider training, implementation and monitoring of evidence-based treatment services for children and adolescents. The LME-MCO and providers have in effect systems to protect from inappropriate disclosure patient records maintained by the LME-MCO and the provider in connection with an activity funded under the program involved or by any entity, which is receiving amounts from the grant and for SA under 42 CFR Part 2. Audit Objectives a. To ensure compliance with the DHHS and DMH/DD/SAS records retention schedules and policies. b. To ensure compliance with all federal and State policies, laws and rules that pertain to this fund source and/or to the contract/grant agreement. c. To ensure that Mental Health Block Grant funds were not awarded to private for-profit entities. Suggested Audit Procedures a. Verify that records related to this fund source are in compliance with DHHS- DMH/DD/SAS program record policies. b. Review contract/grant agreement, identify any special requirements, and verify if the requirements were met. c. Verify that financial assistance under the Mental Health Block Grant was only provided to public or non-profit entities and that funds were expended within the state and federal guidelines. d. When applicable, verify that the grantee has obtained a DUNS number and is registered in the Central Contractor Registration (CCR) system. Conflict of Interest and Certification of No Overdue Tax Debts All non-state entities (except those entities subject to the audit and other reporting requirements of the Local Government Commission) that receive, use or expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are subject to the financial reporting requirements of G. S. 143C-6-23 effective July 1, 2007. These requirements include the submission of a Notarized Conflict of Interest Policy (see G. S. 143C-6-23(b)) and a written statement (if applicable) that the entity does not have any overdue tax debts as defined by G. S. 105-243.1 at the federal, State or local level (see G. S. 143C-6-23(c)). G. S. 143C-6-23(b) stipulates that every grantee shall file with the State agency disbursing funds to the grantee a copy of that grantee s policy addressing conflicts of interest that may arise involving the grantee's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the grantee s employees or members of its board or other governing body, from the grantee s disbursing of State funds, and shall include actions to be taken by the grantee or the individual, or both, to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the disbursing State agency may disburse the grant funds. All non-state entities that provide State funding to a non-state entity (except any non-state entity subject to the audit and other reporting requirements of the Local Government Commission) must hold the subgrantee accountable for the legal and appropriate expenditure of those State grant funds. B-4 93.958 14